Medical Students

About the USMLE Step 2 Exams

Few things in the third year are as anxiety-provoking as the United States Medical Licensing Examination ® (USMLE®) Step 2 examinations. If you are preparing for them, here are several important things to remember.

Much of the anxiety comes from not knowing what to expect on the exams. Each student who has taken the tests has an opinion of how difficult they were and the best way to prepare, and hearing different views of the exam experience can be quite anxiety provoking. A good place to start is by reviewing the USMLE bulletin, which outlines the details of what to expect on the exam (in terms of content and structure) and specifically what happens on the day of the test. The USMLE also makes available orientation and practice materials that may be helpful in your preparation.

Remember that the purpose of the Step 2 exams (both clinical knowledge and clinical skills) is to assess your ability to apply medical knowledge, skills, and understanding of clinical science needed to provide patient care under supervision and provide the foundation for the safe and competent practice of medicine. Although these goals may sound lofty, they are really what you have spent the past 3 years working on and are the logical extension of your path through medical training. Medical schools are keenly aware of what needs to be taught to meet these goals, and your coursework and clinical training experiences have been structured to provide you with what you need to be successful on the exams. Rest assured that you have been exposed to the core content and concepts that will be covered on the tests, and if you have worked hard and done well through your courses and rotations, you should already be well prepared; your task is to make sure you are comfortable with what you need to know. How this is done varies by each individual as learning and study styles differ markedly. However, use what works best for you in terms of study methods and materials.

And perhaps most importantly, keep the exams in greater perspective. Although they are obviously an important part of the medical training process, many students tend to focus on maximizing their USMLE scores, sometimes to the detriment of their overall medical training. Remember that USMLE scores are intended to be one component of your overall application for residency training, and not a single indicator of your competitiveness for a specific discipline or training program. Although some highly competitive specialties place considerable emphasis on USMLE scores, the vast majority of internal medicine residencies do not have absolute score levels below which applications will not be considered. Obviously, doing well on the exam is very helpful, particularly for more competitive programs, and very low scores usually raise some concern. However, most programs understand that the level of USMLE scores are not an accurate independent predictor of whether you would make a good internist or not, and they typically rely on other aspects of your application (such as letters of recommendation and performance evaluations), in addition to your exam scores, when considering your application for residency. So while it is always preferable to do well on the exams, a focus on attempting to achieve a specific numerical score is often less than helpful, may distract from your overall learning of medicine, and may inordinately increase your anxiety level.

So as you approach this important step in your training, study well, do your best, try to relax, and good luck!

IM Essentials brings the self-assessment questions currently in MKSAP for Students and the textbook content of Internal Medicine Essentials for Clerkship Students together into a single, updated and integrated suite of educational materials with a variety of new enhancements. Learn more.